Torsades de Pointes

The first 10 minutes of emergency medicine resuscitation of torsades de pointes

Case

A 46 year old female is referred into the emergency department after multiple syncopal episodes. Her family physician did blood work and found her to be hypokalemic. She is on venlafaxine for depression and amitriptyline for sciatica. She is currently on a course of moxifloxacin for her sinusitis and this morning took a dose of fluconazole for the resultant candidiasis. On arrival, she is alert and looks well. However, as the ECG is being performed, she slumps over and you see:

ECG52105_3_hypoK.jpg

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Thyroid storm

The emergency department management of severe, decompensated hyperthyroidism

Case

A 45 year old woman with a past medical history of hyperthyroidism is brought into the emergency department by her partner. She has had urinary tract symptoms for the last 2 days, but now she looks really sick. She has been having diarrhea and crampy abdominal pain. She is having a hard time concentrating, is tremulous, and drenched in sweat. Her vital signs at triage include an irregular heart rate of 142 and a temperature of 39.5 degrees celsius. Continue reading “Thyroid storm”

Resuscitation of the crashing infant

An approach the the initial resuscitation of the critically ill child

Case

It is your last of 3 night shifts, but so far it has been great. You successfully resuscitated a woman with severe postpartum hemorrhage. You got ROSC on a young cardiac arrest patient, and just heard that he is awake and talking after having his LAD opened in the cath lab. You even managed to get the Cunningham technique to work on a dislocated shoulder for the first time in your career. Now, during a lull, you are joking with the nurses, and someone says the work “quiet”. The next minute, the triage nurses is running down the hallway with a limp, blue 3 week infant in her arms and 2 very scared parents in tow…

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Emergent Cardiac Pacing

How to set up emergency cardiac pacing

Case

The 67 year old bradycardic patient from the previous case has a heart rate of 38 and a blood pressure of 68/45. It is time to start pacing… Continue reading “Emergent Cardiac Pacing”

Managing unstable bradycardia

A brief overview of the initial management of unstable bradycardia in the emergency department

Case

A 67 year old man is brought in by EMS after a syncopal episode at home. He has only partially regained consciousness, with a GCS of 12. His wife says that he has had a fast heart rate before and that he also has diabetes and high blood pressure. She isn’t sure what medications he is on. He has had flu like symptoms for a few days. The paramedic vital signs were a heart rate of 38, a blood pressure of 69/45, a respiratory rate of 22. The oxygen saturation tracing has been inconsistent, but they think it is probably about 91% on room air… Continue reading “Managing unstable bradycardia”

Management of the Massive GI Bleed

A brief summary of the initial emergency department resuscitation of a patient with massive gastrointestinal bleeding

Case

You are called urgently to resuscitation. Walking into the room, you recognize a familiar face. In fact, didn’t you discharge him home yesterday with epigastric pain that you attributed to his chronic alcohol use? Today’s diagnosis is not a mystery. There is already a puddle of blood on the floor, and he is quickly filling another emesis basin with bright red blood. A glance at the monitor reveals a heart rate of 135 and a blood pressure of 74/34…

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Balloon tamponade of massive GI bleeding

A brief summary of the procedure of balloon tamponade in massive upper gastrointestinal haemorrhage

Case

You have been resuscitating the 62 year old man with a massive GI bleed from the previous post. You started your massive transfusion protocol and have him safely intubated. However, he continues to bleed, and you need to transfer him out of your small community hospital…

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